Endoscopic appearance of duplicated middle turbinate, case series and literature review

Abdulaziz Saud AlEnazi; Shahad Ali Alzahrani; Adnan Al-Samarah; Mona MohammedSaleh Ashoor

doi:10.1016/j.ijscr.2023.107919

Endoscopic appearance of duplicated middle turbinate, case series and literature review

Int J Surg Case Rep. 2023 Mar:104:107919. doi: 10.1016/j.ijscr.2023.107919. Epub 2023 Feb 7.

Authors

Abdulaziz Saud AlEnazi¹, Shahad Ali Alzahrani², Adnan Al-Samarah³, Mona MohammedSaleh Ashoor⁴

Affiliations

¹ Department of Otolaryngology -Head and Neck surgery, Imam Abdul Rahman bin Faisal University, King Fahd Hospital of the University (KFHU), Al Khobar, Saudi Arabia. Electronic address: asenazi@iau.edu.sa.
² College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University (KFHU), Al Khobar, Saudi Arabia. Electronic address: 2170000366@iau.edu.sa.
³ Radiology Department, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University (KFHU), Al Khobar, Saudi Arabia. Electronic address: asamarah@iau.edu.sa.
⁴ Department of Otolaryngology -Head and Neck surgery, Imam Abdul Rahman bin Faisal University, King Fahd Hospital of the University (KFHU), Al Khobar, Saudi Arabia. Electronic address: mashoor@iau.edu.sa.

Abstract

Introduction and importance: Duplication of the middle turbinate is an extremely rare condition encountered in rhinology clinic. Knowledge and awareness of the nasal turbinates' variations are important to perform a safe endoscopic surgery and evaluate patients with inflammatory sinus diseases.

Case presentation: Case series of two patients who visited rhinology clinic in academic university hospital. Case 1: presented with 6-month history of nasal blockage. Nasal endoscopy revealed bilateral duplication of the middle nasal turbinates. Computed tomography scans showed bilateral medially curved and anteriorly folded uncinate process, and right middle turbinate concha bullosa and its superior end of the middle turbinate was turned medially. Case 2: A 29-year-old gentleman presented with nasal obstruction mainly to the left side for several years. Nasal endoscopy showed bifid right middle turbinate and severe deviated nasal septum to the left. Upon imaging, a sinus computed tomography scan demonstrated a duplication of the right middle turbinates in the form of two middle nasal concha.

Clinical discussion: Different rare anatomical variations can occur at different points during the embryological development. These rare variations include double middle turbinate, accessory middle turbinate, secondary middle turbinate, and bifid inferior turbinate. The appearance of double middle turbinate can be encountered in rhinology clinic only 2 % of the time. Upon reviewing the literature, only few case reports were found regarding the double middle turbinate.

Conclusion: A double middle turbinate has important clinical implications. Anatomical variation may lead to narrowing in the middle meatus which makes the patient vulnerable to sinusitis or maybe associated with secondary symptoms. We report rare cases of middle turbinate duplication. Awareness of the nasal turbinates' variations is important for detection and management of inflammatory sinus diseases. Further studies are needed to identify the association of other pathology.

Keywords: Accessory turbinate; Duplication; Middle turbinate.